Provider Demographics
NPI:1295829364
Name:COLLADO, KRISTIN P (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:P
Last Name:COLLADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 RICHMOND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1524
Mailing Address - Country:US
Mailing Address - Phone:716-341-5855
Mailing Address - Fax:
Practice Address - Street 1:570 RICHMOND AVE APT 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1524
Practice Address - Country:US
Practice Address - Phone:716-341-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0167GOtherBCBSNC
NC2624961OtherUHC
NC91934OtherMEDCOST
NC0167GOtherBCBSNC
NC2624961OtherUHC
NC2752805Medicare PIN